Inpatient utilization

PGIP Matters article — published October 2011

Value Partnerships is continuously evaluating all of the initiatives that are a part of the Physician Group Incentive Program. The Inpatient Utilization Initiative was launched in 2009 with the goal of providing data on hospital admissions to reduce variations in care and prevent unnecessary hospital admissions. Performance among PGIP Physician Organizations participating in IPU initiative has shown little to no improvement when compared to POs that are not participating in this initiative.

Recently, we invited Physician Organizations to participate in an Inpatient Utilization Initiative workgroup to help us gain a better understanding of the challenges and opportunities associated with this initiative. Two workgroups were held, one held in Southeast Michigan and the other in West Michigan. The meetings assisted in assessing overall PO perceptions about the IPU Initiative and to determine factors influencing PO outcomes, challenges to initiative implementation, areas of improvement and ways to support the development of Organized Systems of Care.

Based on PO feedback and further internal assessment, Value Partnerships has determined a need for redesigning the IPU Initiative. As we move forward, BCBSM has assigned two internal teams to focus on the redesign process and create a revised initiative that will empower POs to manage inpatient utilization costs effectively. The teams will also examine effective methods of aligning the PO incentives provided through the IPU Initiative with the hospital incentives provided through the BCBSM Hospital Pay-for-Performance program. This collective effort aimed at optimizing use of costly inpatient services is vital to our success in moderating health care costs so as to assure that our evolving health care system is affordable and sustainable.

Since the IPU Initiative is being redesigned we will be pulling the current IPU Initiative from initiative selection in 2012. For POs that are currently participating in the IPU Initiative, BCBSM will continue to evaluate, score and pay on the results for the January 2012 payment. We anticipate that a newly designed IPU Initiative will reemerge in the 2013 program year.

For POs that have any questions, please contact Bharath Mamathambika at 313-448-3336 or email bmamathambika@bcbsm.com.